Broker Forms

To best serve our brokers, Chorus Community Health Plans has compiled a list of key forms to assist you.

Agent Appointment Forms

• Business Associate Agreement
  
  

Enrollment Forms

• 2024 Enrollment Application
• 2024 Dental Enrollment Application
  
  

Miscellaneous Broker Forms

• Agent of Record Change Form
• Off-Exchange Cancellation Form
  
• PHI Release Form
• Automatic Payment Election Form​

Program and Benefit Flyers

• Member materials
• FoodSmart Program Overview 
• Healthy Mom Healthy Baby Program 
• Freespira Program Overview
• Service Area